Grant Number:	2R01CA093772-05A2 Interpret this number
Primary Investigator:	Silliman, Rebecca
Organization:	Boston Medical Center
Project Title:	Long-Term Survivorship in Older Women with Early Stage Breast Cancer
Fiscal Year:	2008

DESCRIPTION (provided by applicant): Earlier diagnosis, improved treatment, and the overall increase in longevity in later life continue to expand the number of breast cancer survivors who are 65+ years of age, already estimated to be one million (43%) of the total 2.3 million breast cancer survivors. This group of older breast cancer survivors represents 17% of all older cancer survivors, yet the impact of breast cancer and its treatment on survivorship is poorly understood. The parent study (Breast Cancer Treatment Effectiveness in Older Women - BOW I) studied 1859 women 65+ years of age with early stage breast cancer and provided strong evidence that variations in care have substantial consequences for older women: less-than-standard treatment is associated with increased rates of recurrence and breast cancer-specific mortality,while mammography surveillance during the first 5 years after diagnosis is associated with a reduced rate of breast cancer mortality. However, little is known about the effectiveness of mammography surveillance for recurrence and second primaries beyond five years; the cost implications associated with short-term and long-term survivorship care; and the risk of late treatment effects. Responding to the survivorship research priorities of the National Cancer Institute (NCI) and the Institute of Medicine (IOM) to understand and reduce the adverse effects of cancer treatment in older adults, this renewal project (BOW II) will collect additional information about the BOW I breast cancer cohort through 15 years after diagnosis. A comparison cohort of women without breast cancer will be enrolled and matched on age, study site, and breast cancer diagnosis year that will be followed for the same period of time. We will characterize the survivorship of older breast cancer patients and in relation to a comparison cohort cared for in integrated health care systems through the efficient collection of data from medical records and electronic sources. This uniquely detailed dataset, collected by an experienced interdisciplinary team of investigators, will provide new knowledge in three domains of survivorship research: follow-up care, health care costs, late effects of treatment. Both BOW I and II take advantage of the resources of the recently renewed Cancer Research Network (CRN). BOW specific aims will be: (1) To determine whether surveillance mammography beyond 5 years following diagnosis reduces breast cancer-specific mortality, and explore whether surveillance mammography is cost-effective. (2) To determine the cost-effectiveness of standard primary tumor therapy (breast conserving surgery [BCS] followed by radiation therapy or mastectomy) and adjuvant (tamoxifen) therapy, compared with less-than- standard therapy, for older women with breast cancer. (3) To identify late effects of breast cancer and its treatment by comparing incident comorbidity in 5-year breast cancer survivors to a matched comparison cohort without breast cancer. PUBLIC HEALTH RELEVANCE: The average age of all cancer patients is 70 years, and this is projected to increase to 75 years by 2030. BOW II will characterize the survivorship of older breast cancer patients cared for in integrated health care systems where complete data collection through 15 years of follow-up can be accomplished efficiently. It will provide much needed evidence about the effectiveness of surveillance mammography and the occurrence of late effects which, together with cost analyses, will inform the design of systems changes to promote evidence- based survivorship care for older breast cancer survivors.




SAT: a Surrogate-Assisted Two-wave case boosting sampling method, with application to EHR-based association studies.
Authors: Liu X. , Chubak J. , Hubbard R.A. , Chen Y. .
Source: Journal Of The American Medical Informatics Association : Jamia, 2021-12-28 00:00:00.0; , .
EPub date: 2021-12-28 00:00:00.0.
PMID: 34962283
Related Citations

Incorporating Breast Cancer Recurrence Events Into Population-Based Cancer Registries Using Medical Claims: Cohort Study.
Authors: A'mar T. , Beatty J.D. , Fedorenko C. , Markowitz D. , Corey T. , Lange J. , Schwartz S.M. , Huang B. , Chubak J. , Etzioni R. .
Source: Jmir Cancer, 2020-08-17 00:00:00.0; 6(2), p. e18143.
EPub date: 2020-08-17 00:00:00.0.
PMID: 32804084
Related Citations

Risk of second breast cancer events with chronic opioid use in breast cancer survivors.
Authors: Boudreau D.M. , Chen L. , Yu O. , Bowles E.J.A. , Chubak J. .
Source: Pharmacoepidemiology And Drug Safety, 2019 May; 28(5), p. 740-753.
EPub date: 2019-04-03 00:00:00.0.
PMID: 30945381
Related Citations

Breast Cancer Outcomes in a Racially and Ethnically Diverse Cohort of Insured Women.
Authors: Haque R. , Xu X. , Shi J. , Kwan M.L. , Chlebowski R.T. .
Source: Ethnicity & Disease, 2018 Fall; 28(4), p. 565-574.
EPub date: 2018-10-18 00:00:00.0.
PMID: 30405302
Related Citations

Evidence For Detection Bias By Medication Use In A Cohort Study Of Breast Cancer Survivors
Authors: Wirtz H.S. , Calip G.S. , Buist D.S.M. , Gralow J.R. , Barlow W.E. , Gray S. , Boudreau D.M. .
Source: American Journal Of Epidemiology, 2017-04-15 00:00:00.0; 185(8), p. 661-672.
PMID: 28338879
Related Citations

Tamoxifen and Antidepressant Drug Interaction in a Cohort of 16,887 Breast Cancer Survivors.
Authors: Haque R. , Shi J. , Schottinger J.E. , Ahmed S.A. , Cheetham T.C. , Chung J. , Avila C. , Kleinman K. , Habel L.A. , Fletcher S.W. , et al. .
Source: Journal Of The National Cancer Institute, 2016 Mar; 108(3), .
PMID: 26631176
Related Citations

Aromatase Inhibitors, Tamoxifen, And Endometrial Cancer In Breast Cancer Survivors
Authors: Chlebowski R.T. , Schottinger J.E. , Shi J. , Chung J. , Haque R. .
Source: Cancer, 2015-07-01 00:00:00.0; 121(13), p. 2147-55.
PMID: 25757699
Related Citations

Incident Comorbidities And All-cause Mortality Among 5-year Survivors Of Stage I And Ii Breast Cancer Diagnosed At Age 65 Or Older: A Prospective-matched Cohort Study
Authors: Jordan J.H. , Thwin S.S. , Lash T.L. , Buist D.S. , Field T.S. , Haque R. , Pawloski P.A. , Petersen H.V. , Prout M.N. , Quinn V.P. , et al. .
Source: Breast Cancer Research And Treatment, 2014 Jul; 146(2), p. 401-9.
PMID: 24939060
Related Citations

Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer.
Authors: Boudreau D.M. , Yu O. , Chubak J. , Wirtz H.S. , Bowles E.J. , Fujii M. , Buist D.S. .
Source: Breast Cancer Research And Treatment, 2014 Apr; 144(2), p. 405-16.
PMID: 24557337
Related Citations

Comprehensive Evaluation Of The Incidence Of Late Effects In 5-year Survivors Of Breast Cancer
Authors: Lash T.L. , Thwin S.S. , Yood M.U. , Geiger A.M. , Bosco J. , Quinn V.P. , Field T.S. , Pawloski P.A. , Silliman R.A. .
Source: Breast Cancer Research And Treatment, 2014 Apr; 144(3), p. 643-63.
PMID: 24584822
Related Citations

Using natural language processing to improve efficiency of manual chart abstraction in research: the case of breast cancer recurrence.
Authors: Carrell D.S. , Halgrim S. , Tran D.T. , Buist D.S. , Chubak J. , Chapman W.W. , Savova G. .
Source: American Journal Of Epidemiology, 2014-03-15 00:00:00.0; 179(6), p. 749-58.
EPub date: 2014-03-15 00:00:00.0.
PMID: 24488511
Related Citations

Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors.
Authors: Wirtz H.S. , Boudreau D.M. , Gralow J.R. , Barlow W.E. , Gray S. , Bowles E.J. , Buist D.S. .
Source: Breast Cancer Research And Treatment, 2014 Feb; 143(3), p. 541-50.
PMID: 24407530
Related Citations

Comorbidities and cardiovascular disease risk in older breast cancer survivors.
Authors: Haque R. , Prout M. , Geiger A.M. , Kamineni A. , Thwin S.S. , Avila C. , Silliman R.A. , Quinn V. , Yood M.U. .
Source: The American Journal Of Managed Care, 2014; 20(1), p. 86-92.
PMID: 24512167
Related Citations

Long-term Surveillance Mammography And Mortality In Older Women With A History Of Early Stage Invasive Breast Cancer
Authors: Buist D.S. , Bosco J.L. , Silliman R.A. , Gold H.T. , Field T. , Yood M.U. , Quinn V.P. , Prout M. , Lash T.L. , Breast Cancer Outcomes in Older Women (BOW) Investigators .
Source: Breast Cancer Research And Treatment, 2013 Nov; 142(1), p. 153-63.
PMID: 24113745
Related Citations

Fracture Risk In Older, Long-term Survivors Of Early-stage Breast Cancer
Authors: Pawloski P.A. , Geiger A.M. , Haque R. , Kamineni A. , Fouayzi H. , Ogarek J. , Petersen H.V. , Bosco J.L. , Thwin S.S. , Silliman R.A. , et al. .
Source: Journal Of The American Geriatrics Society, 2013 Jun; 61(6), p. 888-95.
PMID: 23647433
Related Citations

Incident Malignancies Among Older Long-term Breast Cancer Survivors And An Age-matched And Site-matched Nonbreast Cancer Comparison Group Over 10 Years Of Follow-up
Authors: Clough-Gorr K.M. , Thwin S.S. , Bosco J.L. , Silliman R.A. , Buist D.S. , Pawloski P.A. , Quinn V.P. , Prout M.N. .
Source: Cancer, 2013-04-15 00:00:00.0; 119(8), p. 1478-85.
PMID: 23280284
Related Citations

Lasagna plots made in different (statistical) ovens.
Authors: Gao H. , Buist D.S. , Lash T.L. , Bosco J.L. , Swihart B. .
Source: Epidemiology (cambridge, Mass.), 2012 Nov; 23(6), p. 934.
PMID: 23038124
Related Citations

Age, Comorbidity, And Breast Cancer Severity: Impact On Receipt Of Definitive Local Therapy And Rate Of Recurrence Among Older Women With Early-stage Breast Cancer
Authors: Field T.S. , Bosco J.L. , Prout M.N. , Gold H.T. , Cutrona S. , Pawloski P.A. , Ulcickas Yood M. , Quinn V.P. , Thwin S.S. , Silliman R.A. .
Source: Journal Of The American College Of Surgeons, 2011 Dec; 213(6), p. 757-65.
PMID: 22014658
Related Citations

Long-term Safety Of Radiotherapy And Breast Cancer Laterality In Older Survivors
Authors: Haque R. , Yood M.U. , Geiger A.M. , Kamineni A. , Avila C.C. , Shi J. , Silliman R.A. , Quinn V.P. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2011 Oct; 20(10), p. 2120-6.
PMID: 21878589
Related Citations

A Most Stubborn Bias: No Adjustment Method Fully Resolves Confounding By Indication In Observational Studies
Authors: Bosco J.L. , Silliman R.A. , Thwin S.S. , Geiger A.M. , Buist D.S. , Prout M.N. , Yood M.U. , Haque R. , Wei F. , Lash T.L. .
Source: Journal Of Clinical Epidemiology, 2010 Jan; 63(1), p. 64-74.
PMID: 19457638
Related Citations

Breast Cancer Recurrence In Older Women Five To Ten Years After Diagnosis
Authors: Bosco J.L. , Lash T.L. , Prout M.N. , Buist D.S. , Geiger A.M. , Haque R. , Wei F. , Silliman R.A. , BOW Investigators .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2009 Nov; 18(11), p. 2979-83.
PMID: 19843686
Related Citations

Delayed Radiotherapy For Breast Cancer Patients In Integrated Delivery Systems
Authors: Gold H.T. , Thwin S.S. , Buist D.S. , Field T.S. , Wei F. , Yood M.U. , Lash T.L. , Quinn V.P. , Geiger A.M. , Silliman R.A. .
Source: The American Journal Of Managed Care, 2009 Nov; 15(11), p. 785-9.
PMID: 19895182
Related Citations

When cancer in older adults is undermanaged: the breast cancer story.
Authors: Silliman R.A. .
Source: Journal Of The American Geriatrics Society, 2009 Nov; 57 Suppl 2, p. S259-61.
PMID: 20122024
Related Citations

Referral, Receipt, And Completion Of Chemotherapy In Patients With Early-stage Breast Cancer Older Than 65 Years And At High Risk Of Breast Cancer Recurrence
Authors: Buist D.S. , Chubak J. , Prout M. , Yood M.U. , Bosco J.L. , Thwin S.S. , Gold H.T. , Owusu C. , Field T.S. , Quinn V.P. , et al. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2009-09-20 00:00:00.0; 27(27), p. 4508-14.
PMID: 19687341
Related Citations

Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors.
Authors: Ahern T.P. , Lash T.L. , Thwin S.S. , Silliman R.A. .
Source: Medical Care, 2009 Jan; 47(1), p. 73-9.
PMID: 19106734
Related Citations

Potential Misinterpretations Caused By Collapsing Upper Categories Of Comorbidity Indices: An Illustration From A Cohort Of Older Breast Cancer Survivors
Authors: Ahern,T.P. , Bosco,J.L. , Silliman,R.A. , Yood,M.U. , Field,T.S. , Wei,F. , Lash,T.L. .
Source: Clinical Epidemiology, 2009; 1, p. 93-100.
PMID: 20865090
Related Citations

Breast Cancer Recurrence Risk In Relation To Antidepressant Use After Diagnosis
Authors: Chubak J. , Buist D.S. , Boudreau D.M. , Rossing M.A. , Lumley T. , Weiss N.S. .
Source: Breast Cancer Research And Treatment, 2008 Nov; 112(1), p. 123-32.
PMID: 18058227
Related Citations

Under Utilization Of Surveillance Mammography Among Older Breast Cancer Survivors
Authors: Field T.S. , Doubeni C. , Fox M.P. , Buist D.S. , Wei F. , Geiger A.M. , Quinn V.P. , Lash T.L. , Prout M.N. , Yood M.U. , et al. .
Source: Journal Of General Internal Medicine, 2008 Feb; 23(2), p. 158-63.
PMID: 18060463
Related Citations

Predictors Of Tamoxifen Discontinuation Among Older Women With Estrogen Receptor-positive Breast Cancer
Authors: Owusu C. , Buist D.S. , Field T.S. , Lash T.L. , Thwin S.S. , Geiger A.M. , Quinn V.P. , Frost F. , Prout M. , Yood M.U. , et al. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2008-02-01 00:00:00.0; 26(4), p. 549-55.
PMID: 18071188
Related Citations

Mortality Impact Of Less-than-standard Therapy In Older Breast Cancer Patients
Authors: Yood M.U. , Owusu C. , Buist D.S. , Geiger A.M. , Field T.S. , Thwin S.S. , Lash T.L. , Prout M.N. , Wei F. , Quinn V.P. , et al. .
Source: Journal Of The American College Of Surgeons, 2008 Jan; 206(1), p. 66-75.
PMID: 18155570
Related Citations

Receipt Of Appropriate Primary Breast Cancer Therapy And Adjuvant Therapy Are Not Associated With Obesity In Older Women With Access To Health Care
Authors: Buist D.S. , Ichikawa L. , Prout M.N. , Yood M.U. , Field T.S. , Owusu C. , Geiger A.M. , Quinn V.P. , Wei F. , Silliman R.A. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2007-08-10 00:00:00.0; 25(23), p. 3428-36.
PMID: 17687148
Related Citations

Effectiveness Of Adjuvant Tamoxifen Therapy Among Older Women With Early Stage Breast Cancer
Authors: Owusu C. , Lash T.L. , Silliman R.A. .
Source: The Breast Journal, 2007 Jul-Aug; 13(4), p. 374-82.
PMID: 17593042
Related Citations

Using Probabilistic Corrections To Account For Abstractor Agreement In Medical Record Reviews
Authors: Lash T.L. , Fox M.P. , Thwin S.S. , Geiger A.M. , Buist D.S. , Wei F. , Field T.S. , Yood M.U. , Frost F.J. , Quinn V.P. , et al. .
Source: American Journal Of Epidemiology, 2007-06-15 00:00:00.0; 165(12), p. 1454-61.
PMID: 17406006
Related Citations

Effect Of Undertreatment On The Disparity In Age-related Breast Cancer-specific Survival Among Older Women
Authors: Owusu C. , Lash T.L. , Silliman R.A. .
Source: Breast Cancer Research And Treatment, 2007 Apr; 102(2), p. 227-36.
PMID: 17004115
Related Citations

Breast Cancer Treatment Of Older Women In Integrated Health Care Settings
Authors: Enger S.M. , Thwin S.S. , Buist D.S. , Field T. , Frost F. , Geiger A.M. , Lash T.L. , Prout M. , Yood M.U. , Wei F. , et al. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2006-09-20 00:00:00.0; 24(27), p. 4377-83.
PMID: 16983106
Related Citations

Comorbidity: Implications For Research And Practice In Geriatric Oncology
Authors: Satariano W.A. , Silliman R.A. .
Source: Critical Reviews In Oncology/hematology, 2003 Nov; 48(2), p. 239-48.
PMID: 14607386
Related Citations